=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962018861
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KAI STEELE DDS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2020
-----------------------------------------------------
Last Update Date | 09/17/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 455 UPTON DR
-----------------------------------------------------
City | SAINT JOSEPH
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49085-1058
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-983-7888
-----------------------------------------------------
Fax | 369-983-7871
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 455 UPTON DR
-----------------------------------------------------
City | SAINT JOSEPH
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49085-1058
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-983-7888
-----------------------------------------------------
Fax | 369-983-7871
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. KAI BRENDEN STEELE
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 269-983-7888
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------